The main objective of the present review is to compare the existing sewage sludge management solutions in terms of their environmental sustainability. The most commonly used strategies, that include treatment and disposal has been favored within the present state-of-art, considering existing legislation (at European and national level), characterization, ecotoxicology, waste management and actual routs used currently in particular European countries. Selected decision making tools, namely End-of-waste criteria and Life Cycle Assessment has been proposed in order to appropriately assess the possible environmental, economic and technical evaluation of different systems. Therefore, some basic criteria for the best suitable option selection has been described, in the circular economy “from waste to resources” sense. The importance of sewage sludge as a valuable source of matter and energy has been appreciated, as well as a potential risk related to the application of those strategies.